Editor’s Note: Jennifer Prah Ruger is the Amartya Sen Professor of Health Equity, Economics and Policy and Founder and Director of the Health Equity and Policy Lab at the University of Pennsylvania. She is former member of the US Centers for Disease Control and Prevention (CDC) Director’s Advisory Ethics Subcommittee and former chair of the Ethics Special Primary Interest Group of the American Public Health Association. The opinions expressed in this commentary are solely her own. View more opinion articles on CNN.
The White House has rejected the US Centers for Disease Control and Prevention guidelines for reopening the economy.
Many years ago, I served on the CDC Director’s Advisory Ethics Subcommittee. In the wake of SARS, anthrax attacks and avian influenza, the subcommittee’s ethical guidance for public health emergency preparedness and response was important. Guidance stated that ethics should “inform advance planning and organization of emergency response so as to minimize the number of tragic choices that must be made.”
Public health experts agree the US coronavirus response has been problematic. Rather than advance planning, we have repeated, and often conflicting, emergency responses. The number of tragic choices to be made is growing, not shrinking.
What has become of the CDC? The CDC is the national agency tasked with protecting America from threats to our health, safety, and security.
CDCs in South Korea and Taiwan helped those countries act swiftly, decisively and successfully against Covid-19. The Taiwan Centers for Disease Control activated the Central Epidemic Command Center and imposed home quarantines, border restrictions, a face mask distribution system and other preventative measures. The CDCs in Taiwan and South Korea spearheaded rigorous detection and contact tracing, communication, and isolation. Their coordinated approach explains their successes. The motivation: the memory of SARS and MERS. “We can’t ever forget the incident. It is engraved in our mind,” South Korean CDC’s Lee Sang-won said about MERS.
The US, conversely, suffers from pandemic amnesia, a kind of collective myopia. Pandemic amnesia is a toxic combination of underestimated risks, insufficient preparedness and inadequate protection.
With SARS and MERS etched in memory, Taiwan and South Korea bolstered the capabilities of their respective CDC operations. The US, by contrast, cut CDC core emergency preparedness funding by over 30%, or $273 million from FY 2002 to FY 2017. Insufficient funding has meant public health labs have been understaffed or shut down, a keenly felt effect under Covid-19.
We’ve forgotten the CDC, a national treasure that successfully eliminated malaria in the United States and has worked heroically to control multitudes of infectious diseases known to humankind.
Pandemic amnesia is a malaise: a lack of focus, of conscientiousness and dedication, of motivation and stamina. These are risk factors for a different malaise, inept governance. Nothing in the history of humankind has killed more people than infectious disease. Still, initial momentum, investments and problem-solving – and our memory of CDC successes – quickly lapse as outbreaks fade and recede from view.
Pandemic amnesia threatens our health and security. Fortunately, we have a cure for that. Systemic reforms can save lives and money. The US needs to reinvest in the CDC to turn systemic fragility into resilience. Most importantly, we must acknowledge the CDC’s critical role and we must correct misconceptions – false beliefs – that thwart pandemic preparedness.
The first misconception, the helplessness misconception, is that contagions are natural occurrences we can’t control. This notion conflates naturally occurring viruses with human behaviors. Yes, a virus is natural. However, an epidemic is an increase in the incidence of a disease above the expected level. A pandemic is an epidemic’s spread across multiple countries. While pathogens are natural, epidemics and pandemics occur through human behaviors that spread them. Weak policies, institutions and leadership foster these disasters. Pandemics are preventable and controllable. A strong CDC, as Taiwan and South Korea have shown, can and will play a vital role in controlling an outbreak.
A second misconception, the reactionary misconception, is the failure to focus on preparedness capabilities before disaster strikes. It ignores operational readiness. The belief that we can just deal with an infectious disease when it arises is false. The belief that risk is low and doesn’t warrant warning people is false; risk awareness is indispensable. And the belief that the health care sector will save us is false. We need a strong public health sector and a strong CDC. Our current systems are inadequate. Focusing on prevention can strengthen these resources.
The prevention gaps are clear. We still lack a vaccine for HIV/AIDS, decades after its onset. Anti-vaccine sentiment is helping thwart US efforts to suppress even preventable diseases like measles, mumps and rubella.
“Vaccines are a victim of their own success,” notes Dr. Paul Offit, co-inventor of the rotavirus vaccine. “We have largely eliminated the memory of many diseases.”
Finally, a third misconception, let’s call it the “it’s the economy, stupid” misconception, is that pandemic preparedness is not an economic concern. As we’ve discovered only too painfully with Covid-19, this too is false. An unprecedented 33 million Americans have filed for unemployment insurance in the past two months; the jobless rate has almost quadrupled, to 14.7%. Covid-19’s widespread health, economic, and social devastation will reverberate for years ahead.
Pandemic preparedness is significantly underfunded and underappreciated, given its health, social and economic benefits. But it is not visible to the naked eye. If we can’t see it, it doesn’t exist, and if it doesn’t exist it’s not in our memory.
The US faces a perilous choice: continued systemic fragility relying on repeated emergency responses with vast health, social and economic losses, or systemic resilience – including a strong, fully-funded CDC – to safeguard health and security. With the option to save countless lives at a fraction of the cost, the decision is a no-brainer, whether we suffer from amnesia or not.